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Special Features

Debunking the Stigma

By: Gwen Y. Reyes-Amurao, M.D. article_12

Human Immunodeficiency Virus or HIV.

We have heard and read so much about this virus that causes infection and often results in an acquired state of immunodeficiency in an individual. The numbers have increased remarkably over the past few years, with various international and local organizations from both private and public sectors contributing to widespread education which aims to save the lives of many later on.

Definition

According to the World Health Organization (WHO), the Human Immunodeficiency Virus or HIV targets and weakens an individual’s immune system. This leads to immunodeficiency, an overall state that results in increased susceptibility to a wide variety of infections, cancers, and other diseases that those with healthy immune systems can normally fight off. Acquired Immunodeficiency Syndrome or AIDS is an advanced stage of HIV infection.

The US Department of Health and Human Services mentions that in the early stages of infection, a person may not exhibit signs and symptoms at all. However, within two to four weeks of HIV infection, flu-like manifestations may be observed, such as fever, chills, sore throat, and rashes. As the infection progressively weakens the immune system, other symptoms may develop such as swollen lymph nodes, fever, diarrhea and cough. If not addressed early, this usually advances to AIDS within ten years or longer, and can lead to severe symptoms of opportunistic infection such as tuberculosis, cryptococcal meningitis, severe bacterial infections, and cancers like Kaposi’s Sarcoma.

Transmission

HIV is spread through contact and exchange of certain body fluids with an HIV-infected person including blood, breast milk, semen, vaginal, and rectal fluids. Contrary to what many people believe, individuals cannot be infected through common forms of contact such as hugging, kissing, shaking hands, or sharing food and water. 

There are several modes of transmission that put specific individuals at greater risk of incurring the infection such as the following:

  • Having unprotected sex
  • Having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis
  • Sharing contaminated needles, syringes, and other paraphernalia used in administering drugs and drug solutions
  • Receiving unsafe or unsterile injections, blood transfusions, tissue transplantations and body piercings
  • Experiencing accidental needle stick injuries more specifically among health workers

Diagnosis

Although signs and symptoms may not be observed until the later stages of infection, a blood test should be immediately performed once the presence of infection is suspected or any of the risk factors are identified. Serologic tests can now detect the presence of HIV-1/2 and/or HIV p24 antigen. WHO stresses the importance of these tests being done in combination and in a specific order for best results. Technically speaking, these tests help detect antibodies that develop once the virus is already in the blood, and not the virus itself. A person usually develops antibodies to HIV within 28 days of infection, but can already be infectious in the absence of the antibodies.

To encourage more people to come out and be tested, WHO developed recommendations for all HIV testing centers all over the world, following five basic principles when an individual decides to avail of the center’s services and can easily be remembered with these 5 C’s: Consent (Informed), Confidentiality, Counseling, Correct test results, and Connection (linkage to care, treatment, and other services). These principles aim not only to protect the person being tested but to ensure that the most appropriate forms management and treatment are provided for as well.

Prevention through lifestyle practices and limiting exposure to risk factors has helped decrease the occurrence of HIV infection. Nevertheless, HIV continues to be a major global public health issue. In 2016 alone, one million individuals died from HIV-related diseases globally.  Out of 36.7 million people diagnosed with HIV at the end of 2016, close to two million were newly infected.

The Numbers

In the Philippines specifically, the numbers have risen dramatically in the last two years. As stated in the HIV/AIDS and ART Registry of the Philippines or HARP, which was released by the Department of Health (DOH), there has been a total of 45,023 HIV positive cases reported since the first one in 1984 to June 2017, with 90 percent of the total reported cases being asymptomatic at the time of reporting.

An overwhelming 93 percent of this population was male, which was contrary to the earlier years of the epidemic (1984-1990), wherein 62 percent of the cases were female. The median age was reported to be 28 years old, with more than half of the diagnosed population falling between the ages of 25 and 34. The age group with the biggest proportion of cases has alarmingly become younger through the years, with majority belonging to ages 15 to 24.

In the year 2008, the Philippines reported having only one newly diagnosed case daily. As of June 2017, 30 new cases are diagnosed daily. The regions with the most number of reported cases were the National Capital Region (NCR) with 36 percent cases, followed by Regions 4A, 3, 6,7 and 12. Majority of the cases were transmitted through sexual contact, with 84 percent of infections transmitted through male-to-male contact. Other modes of transmission were through needle sharing among drug users and mother-to-child transmission. From January 1984 to June 2017, 28 percent of the reported cases were 15-24 years old, with 86 percent being reported from January 2012 to June 2017 alone. After 2002, there was a sudden shift to males being infected, with the male-male transmission predominantly being the mode of transmission in 96 percent of the cases reported.

Aside from illness or morbidity, mortality or deaths have increased greatly as well. In June 2017 alone, there were 29 reported deaths, 27 of which were male, with 11 cases falling within the 35-49 age range. All were infected through sexual contact, majority of which were from male-male transmission. 

The Future

Because of the increasing rates of occurrence and deaths related to HIV and AIDS, the government, specifically DOH has come up with programs that aim to address the growing concerns of an individual diagnosed with HIV infection or AIDS. As mentioned earlier, WHO cites Connection or linkage to care and services as an important requirement for health facilities that help address this condition.

According to a study published in the Journal of Psychoactive Drugs, given the latest global programs for those afflicted with HIV, there is a need to introduce culturally relevant and culturally appropriate HIV/AIDS programs for the urban youth. This can be done through integration of prevention efforts into the multidimensional and complex social structures of the youth who belong to a particular culture.  Nonetheless, these efforts are also applicable to those who are inflicted with HIV.

It should be noted that from 2016 up to the present, more than half of those who are newly diagnosed are yet to start their treatment. It is for this reason that DOH came up with three main programmatic reforms in 2016. First, the national HIV program developed and piloted the rapid HIV testing algorithm (rHIVda) in different testing facilities all over the country as published in The State of the Philippine HIV Epidemic 2016: Facing Challenges and Forging Solutions. This aimed to reduce long waiting periods by decentralizing confirmatory HIV testing previously done solely by the national reference laboratory.

Second, the 28-fold increase in diagnosed cases from 2009 to 2016 created the much needed impetus for the national program to aggressively increase the number of facilities offering treatment and care particularly within priority areas for HIV intervention. This aimed to decongest the overburdened facilities, create better working conditions for health providers, thereby improve the quality of care received by clients. The number of treatment facilities has increased more than three-fold from 18 in 2013 to 55 in 2016

Third, in June 2016, DOH released Department Circular 2016-0171, directing all treatment facilities to immediately start baseline testing following a reactive screening result. The circular aimed to immediately conduct baseline tests for all HIV-positive individuals.

Looking at these numbers, it can be quite overwhelming, especially in a country as small as ours. But as our society becomes more and more aware of the epidemic that is HIV and AIDS, long-term programs have already been initiated such as the 6th AIDS Medium Term Plan and the 2017-2020 Health Sector Plan, which aim to end AIDS by the year 2030. In the figure below, all the members of the community are tapped in order to address this growing concern. By educating the general population regarding the truth about HIV and AIDS, the program aims not only to treat those already living with it, but also prevent new infection, test and treat people living with HIV, and eliminate completely the mother to child transmission.

The world is well aware of this epidemic, and almost every sector of society has tried to make things better for those who are affected. Through the help of public health and non-health organizations, private groups, civil societies, and even concerned citizens, we can put an end to this presently growing concern.

Although things are starting to look positive, the world still has a lot to deal with especially when it comes to eliminating the stigma that comes with HIV and AIDS. In fact, the Journal of the International AIDS Society mentions that HIV-related stigma and discrimination continues to endanger people living with the virus, preventing individuals from coming forward for testing and treatment services.  Most of them are also unable to exercise their right to health, non-discrimination, and freedom from violence. 

At present, there are now education programs and information campaigns that aim to reduce stigma against those diagnosed with HIV and AIDS. Other countries are also formulating protective laws, and creating legal, social, and policy frameworks that will hopefully, one day, eliminate the stigma and discrimination against HIV. Although it may take time until each and every individual becomes more accepting and understanding of those who are battling with HIV, we can be assured that the small steps being taken now will eventually lead to bigger and life-changing results in the future.


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Keywords: rHIVda, serologic test, blood test, bacterial vaginosis, gonorrhea, chlamydia, herpes, syphilis, STD, Kaposi's Sarcoma, cancer, bacterial infection, cryptococcal meningitis, tuberculosis, immunodeficiency, AIDS, HIV   
  
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